The diminishing role of pelvic x-rays in the management of patients with major torso injuries

Chih Yuan Fu, Shang Yu Wang, Yu Pao Hsu, Chien Hung Liao, Being Chuan Lin, Shih Ching Kang, Kuo Ching Yuan, I. Ming Kuo, Chun Hsiang Ouyang, Shang Ju Yang

Research output: Contribution to journalArticle

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Abstract

Introduction A pelvic x-ray (PXR) can be used as an effective screening tool to evaluate pelvic fractures and stability. However, associated intra-abdominal/retroperitoneal organ injuries and hemorrhage should also be considered and evaluated in patients with major torso injuries. An abdominal/pelvic computed tomographic (CT) scan may provide higher resolution and more information than a PXR. The role of conventional PXRs was delineated in the current study in the context of the development of the CT scan. Materials and Methods We retrospectively reviewed patients with major torso injuries in our institution. The characteristics of the patients who received different diagnostic modalities (PXR only, CT scan only, or both) were investigated and compared. The characteristics of patients who underwent transcatheter arterial embolization (TAE) for the hemostasis of pelvic fracture-related retroperitoneal hemorrhage were also analyzed. Result There were 726 patients enrolled in current stud. Only 72.0% (523/726) of the patients who had major torso injuries were examined using PXRs, and 69.6% (505/726) of the patients underwent an abdominal/pelvic CT scan. For the patients who were examined using PXRs, there was no significant difference in the usage rate of an additional CT scan between the patients with positive (52.7%, 108/205) and negative (61.0%, 194/318) PXR examinations (P =.070). Four patients underwent TAE immediately following PXR examinations only, without a CT scan. These four patients had unstable pelvic fractures on the PXR examination and significantly a lower systolic blood pressure (61.0 ± 13.0 mmHg), a lower revised trauma score (3.560 ± 2.427), a greater requirement for blood transfusions (1750 ± 957.2 ml) than the patients who underwent TAE after a CT scan. Conclusion For the management of patients with major torso injuries, the role of PXR is diminishing due to the development of the CT scan. However, the PXR is still valuable for patients who are in critical condition and have an obviously high probability of retroperitoneal hemorrhaging.

Original languageEnglish
Pages (from-to)18-23
Number of pages6
JournalAmerican Journal of Emergency Medicine
Volume32
Issue number1
DOIs
Publication statusPublished - Jan 1 2014
Externally publishedYes

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Torso
X-Rays
Wounds and Injuries
Hemorrhage
Blood Pressure
Hemostasis
Blood Transfusion

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Fu, C. Y., Wang, S. Y., Hsu, Y. P., Liao, C. H., Lin, B. C., Kang, S. C., ... Yang, S. J. (2014). The diminishing role of pelvic x-rays in the management of patients with major torso injuries. American Journal of Emergency Medicine, 32(1), 18-23. https://doi.org/10.1016/j.ajem.2013.09.011

The diminishing role of pelvic x-rays in the management of patients with major torso injuries. / Fu, Chih Yuan; Wang, Shang Yu; Hsu, Yu Pao; Liao, Chien Hung; Lin, Being Chuan; Kang, Shih Ching; Yuan, Kuo Ching; Kuo, I. Ming; Ouyang, Chun Hsiang; Yang, Shang Ju.

In: American Journal of Emergency Medicine, Vol. 32, No. 1, 01.01.2014, p. 18-23.

Research output: Contribution to journalArticle

Fu, CY, Wang, SY, Hsu, YP, Liao, CH, Lin, BC, Kang, SC, Yuan, KC, Kuo, IM, Ouyang, CH & Yang, SJ 2014, 'The diminishing role of pelvic x-rays in the management of patients with major torso injuries', American Journal of Emergency Medicine, vol. 32, no. 1, pp. 18-23. https://doi.org/10.1016/j.ajem.2013.09.011
Fu, Chih Yuan ; Wang, Shang Yu ; Hsu, Yu Pao ; Liao, Chien Hung ; Lin, Being Chuan ; Kang, Shih Ching ; Yuan, Kuo Ching ; Kuo, I. Ming ; Ouyang, Chun Hsiang ; Yang, Shang Ju. / The diminishing role of pelvic x-rays in the management of patients with major torso injuries. In: American Journal of Emergency Medicine. 2014 ; Vol. 32, No. 1. pp. 18-23.
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abstract = "Introduction A pelvic x-ray (PXR) can be used as an effective screening tool to evaluate pelvic fractures and stability. However, associated intra-abdominal/retroperitoneal organ injuries and hemorrhage should also be considered and evaluated in patients with major torso injuries. An abdominal/pelvic computed tomographic (CT) scan may provide higher resolution and more information than a PXR. The role of conventional PXRs was delineated in the current study in the context of the development of the CT scan. Materials and Methods We retrospectively reviewed patients with major torso injuries in our institution. The characteristics of the patients who received different diagnostic modalities (PXR only, CT scan only, or both) were investigated and compared. The characteristics of patients who underwent transcatheter arterial embolization (TAE) for the hemostasis of pelvic fracture-related retroperitoneal hemorrhage were also analyzed. Result There were 726 patients enrolled in current stud. Only 72.0{\%} (523/726) of the patients who had major torso injuries were examined using PXRs, and 69.6{\%} (505/726) of the patients underwent an abdominal/pelvic CT scan. For the patients who were examined using PXRs, there was no significant difference in the usage rate of an additional CT scan between the patients with positive (52.7{\%}, 108/205) and negative (61.0{\%}, 194/318) PXR examinations (P =.070). Four patients underwent TAE immediately following PXR examinations only, without a CT scan. These four patients had unstable pelvic fractures on the PXR examination and significantly a lower systolic blood pressure (61.0 ± 13.0 mmHg), a lower revised trauma score (3.560 ± 2.427), a greater requirement for blood transfusions (1750 ± 957.2 ml) than the patients who underwent TAE after a CT scan. Conclusion For the management of patients with major torso injuries, the role of PXR is diminishing due to the development of the CT scan. However, the PXR is still valuable for patients who are in critical condition and have an obviously high probability of retroperitoneal hemorrhaging.",
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AU - Wang, Shang Yu

AU - Hsu, Yu Pao

AU - Liao, Chien Hung

AU - Lin, Being Chuan

AU - Kang, Shih Ching

AU - Yuan, Kuo Ching

AU - Kuo, I. Ming

AU - Ouyang, Chun Hsiang

AU - Yang, Shang Ju

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N2 - Introduction A pelvic x-ray (PXR) can be used as an effective screening tool to evaluate pelvic fractures and stability. However, associated intra-abdominal/retroperitoneal organ injuries and hemorrhage should also be considered and evaluated in patients with major torso injuries. An abdominal/pelvic computed tomographic (CT) scan may provide higher resolution and more information than a PXR. The role of conventional PXRs was delineated in the current study in the context of the development of the CT scan. Materials and Methods We retrospectively reviewed patients with major torso injuries in our institution. The characteristics of the patients who received different diagnostic modalities (PXR only, CT scan only, or both) were investigated and compared. The characteristics of patients who underwent transcatheter arterial embolization (TAE) for the hemostasis of pelvic fracture-related retroperitoneal hemorrhage were also analyzed. Result There were 726 patients enrolled in current stud. Only 72.0% (523/726) of the patients who had major torso injuries were examined using PXRs, and 69.6% (505/726) of the patients underwent an abdominal/pelvic CT scan. For the patients who were examined using PXRs, there was no significant difference in the usage rate of an additional CT scan between the patients with positive (52.7%, 108/205) and negative (61.0%, 194/318) PXR examinations (P =.070). Four patients underwent TAE immediately following PXR examinations only, without a CT scan. These four patients had unstable pelvic fractures on the PXR examination and significantly a lower systolic blood pressure (61.0 ± 13.0 mmHg), a lower revised trauma score (3.560 ± 2.427), a greater requirement for blood transfusions (1750 ± 957.2 ml) than the patients who underwent TAE after a CT scan. Conclusion For the management of patients with major torso injuries, the role of PXR is diminishing due to the development of the CT scan. However, the PXR is still valuable for patients who are in critical condition and have an obviously high probability of retroperitoneal hemorrhaging.

AB - Introduction A pelvic x-ray (PXR) can be used as an effective screening tool to evaluate pelvic fractures and stability. However, associated intra-abdominal/retroperitoneal organ injuries and hemorrhage should also be considered and evaluated in patients with major torso injuries. An abdominal/pelvic computed tomographic (CT) scan may provide higher resolution and more information than a PXR. The role of conventional PXRs was delineated in the current study in the context of the development of the CT scan. Materials and Methods We retrospectively reviewed patients with major torso injuries in our institution. The characteristics of the patients who received different diagnostic modalities (PXR only, CT scan only, or both) were investigated and compared. The characteristics of patients who underwent transcatheter arterial embolization (TAE) for the hemostasis of pelvic fracture-related retroperitoneal hemorrhage were also analyzed. Result There were 726 patients enrolled in current stud. Only 72.0% (523/726) of the patients who had major torso injuries were examined using PXRs, and 69.6% (505/726) of the patients underwent an abdominal/pelvic CT scan. For the patients who were examined using PXRs, there was no significant difference in the usage rate of an additional CT scan between the patients with positive (52.7%, 108/205) and negative (61.0%, 194/318) PXR examinations (P =.070). Four patients underwent TAE immediately following PXR examinations only, without a CT scan. These four patients had unstable pelvic fractures on the PXR examination and significantly a lower systolic blood pressure (61.0 ± 13.0 mmHg), a lower revised trauma score (3.560 ± 2.427), a greater requirement for blood transfusions (1750 ± 957.2 ml) than the patients who underwent TAE after a CT scan. Conclusion For the management of patients with major torso injuries, the role of PXR is diminishing due to the development of the CT scan. However, the PXR is still valuable for patients who are in critical condition and have an obviously high probability of retroperitoneal hemorrhaging.

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